| NPI | 1417172826 |
|---|---|
| Former Name | MICKEY MARTINDALE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0472) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 3923) |
| 101YM0800X Counselor, Mental Health (Licence: NM 0472) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2015-04-13 |